Tag: spine

While back pain is very common for adults, kids and teens are much more resilient and flexible and do not suffer the same types of back injuries to which adults are subject. In fact, medically significant back pain in children and teens is infrequently encountered, with even fewer cases in younger children.

Because children rarely suffer from back pain, any complaint by a child or teenager about acute back pain or chronic back pain is taken very seriously by Pediatricians, and usually will result in a detailed consultation that will include a review of the child’s medical history and a physical exam.

Suspicious episodes of back pain, or any concerning features of the pain, will result in radiological studies (such as an x-ray or MRI scan) and possibly a referral to a specialist for further examination and diagnostic tests.

Types of Back Pain in Kids and Teens

The most common causes of back pain in children and teenagers tend to be somewhat age-dependent:

Younger children are less likely to be putting their spine under the same severe stresses as older children and adults. Thus, for the most part younger children do not have medically significant back pain and their discomfort tends to be short-lived. Also, younger children tend to self-limit their activity, choosing not to repeat painful activities, which aids in their recovery if an episode of back pain does occur.

At a young age, if a child has back pain there is greater concern for the possibility of a serious condition, such as a spinal tumor, growth, or an infection of the spine. Therefore, if the back pain persists in a younger child despite a lack of re-injury, or if there are other symptoms suggestive of a more insidious process (infection or tumor), the child’s condition will most likely be considered atypical, and therefore, further work-up and medical examination will be indicated.

Older children tend to be more aggressive in their activities and sports, thereby increasing the risk of injury to the bones, nerves and soft tissues in the spine. Teenagers are also more likely to test the limits of their bodies, often being exhorted by commercial advertising and/or peer pressure to push the envelope.

At this point, compression fractures are more commonplace, and we begin to see occasional disc injuries. Older pediatric patients also can injure the joints between vertebral bones, causing painful stress injuries. Only very rarely do the nerve roots become compromised in older children.

Slightly older children can be convinced to minimize their activity to speed up healing times for back pain, but then they frequently return to the same injurious behavior that caused the initial damage. Here, older kids may also find themselves the victims of their own intermittent inactivity and suffer overuse injuries, similar to an adult who is a “weekend warrior”.

For most injuries and episodes of back pain, the back pain treatment of choice is usually a short period of rest with an eye towards developing and maintaining physical conditioning. Tumors and infection of the spine may occur in teens, but it is more common for back pain in teens to be caused by sports injuries or overuse syndromes.

Scoliosis among Kids and Teens

While scoliosis (curvature of the spine) is not an uncommon diagnosis among teenagers, it is very rare that adolescent scoliosis will cause back pain. Teens with scoliosis may develop back pain, just as other teenagers, but it has not been found that people with adolescent idiopathic scoliosis are any more likely to develop back pain than the rest of the population.

While adults can have vertebral disc injuries involving rupture, protrusion or slipping, and compression, these problems are uncommon in children. However, as kids age and their bodies mature, it becomes more likely that an injury to the spinal discs may occur and cause back pain.

Causes of Back Pain that Tend to Occur Among Older Children:

Spondylolysis. As kids’ sporting events become more competitive and the activities more specialized, certain types of injuries causing back pain tend to arise. Spondylosis, a defect of the joint between vertebral bones, is commonly found in those who tend to hyperextend their backs (bend backwards), such as gymnasts. This injury may actually represent a stress fracture and the period of rest and recuperation may be extensive – up to 4 to 6 weeks.

Spondylolisthesis. Occasionally, further injury can be found as spondylolisthesis, a “slipping” of one vertebra upon another. This condition can progress through adolescence, and if it results in instability and back pain it may require spinal fusion surgery at a later point.

Disc Injuries and vertebral fractures. Teens who tend to punish their spines through gymnastics or extreme sports (such as skateboarding, in-line skating, and vert biking) will frequently land very hard on their feet or buttocks. Either way, the force is transmitted to their vertebrae, which can result in a vertebral fracture and/or damage to the intervertebral discs.

If the disc material is extruded out or herniated, the spinal cord nerve roots leaving the cord can be compressed. This causes the sensation of pain along the path of that nerve. A well-known version of this is sciatica, which presents as buttock pain radiating down the back of a leg. Nonsurgical measures are usually the first line of treatment for this type of pain (such as physical therapy, medications, osteopathic or chiropractic adjustment).

Backpacks and Back Pain Among Kids and Teens

Importantly, pediatricians are starting to see a new form of injury in school-age children and teens become more common: overuse injuries and back strain caused by carrying back packs that are too heavy. Often, backpacks may equal 20% to 40% of the child’s own body weight (equivalent to a 150-pound adult carrying a 30 to 60-pound back pack around 5 days a week). This amount of weight understandably creates a great deal of strain on the child’s spine. Additional strain that may cause back pain comes from children and teens carrying their backpacks over one shoulder, causing an uneven load on the spine.

Careful Process of Diagnosing Back Pain in Kids and Teens

As you may have noted, rest and careful monitoring of symptoms seems to be the answer for most diagnoses. This is because the vast majority of back pain problems in children are related to soft tissue damage (such as muscles, ligaments and tendons), which is often caused by overuse or strain. Surgery for back pain in children is very rare, and is usually only considered for the most severe cases.

Most importantly, a careful process of elimination of medically more significant causes of back pain (such as tumor, infection, fracture) should always precede any therapeutic plan for treating back pain in kids and teens. In addition, a physical spinal assessment should be part of the Pediatrician’s yearly health assessment. Early diagnosis and treatment of childhood spinal abnormalities, such as scoliosis, is imperative to correction before it becomes painful.

While there is currently no proven treatment to stop or slow the progression of osteoarthritis in the spine, there are treatments to alleviate the pain and other associated symptoms, and for most people the condition will not become debilitating. Some patients with osteoarthritis have minimal or no pain, and may not need treatment. Most people who require treatment will benefit from a combination of lifestyle changes such as exercise, weight reduction, and smoking cessation. Most treatment plans for osteoarthritis focus on controlling the pain and improving the patient’s ability to function. In only the most severe cases will surgery be necessary to treat pain and disability from osteoarthritis.

Medical practitioners often refer to osteoarthritis in the spine as spinal arthritis, degenerative joint disease, or arthritis of the facet joints. Spinal arthritis is relatively common and is most likely to occur in people over age fifty. It represents an ongoing, degenerative process in the spine, and may be associated with a number of other degenerative spinal conditions. In particular, osteoarthritis is associated with degenerative discs in the spine.

Degenerative discs and osteoarthritis often occur hand in hand because the disc and facet joints (the joints in the back affected by osteoarthritis) are both part of the same three-joint complex. It is thought that degenerating discs can place undue stress on the facet joints, thus over time leading to degeneration and formation of osteoarthritis in the facet joints (also called zygapophyseal joints). This may be why the two degenerative conditions are so often seen together.

If the disc as well as the facet joints become painful as a result of degenerative changes in the spine, the condition is often called spondylosis. However, degenerative disc disease and osteoarthritis are different conditions and can occur separately: One can have degenerative discs without any facet osteoarthritis; or one can have facet osteoarthritis without degenerative discs. Osteoarthritis of the spine is unlike arthritis of the hip, knee and other joints, as the pain, aches, tiredness and stiffness does not come from just the facet joints but often also from the degenerated discs and inhibition of the spinal extensor muscles.

Most treatment plans will include a combination of non-surgical options, based on assessing several factors for the individual patient, such as: severity of the osteoarthritis, which joints are affected, nature of the symptoms, other existing medical conditions, age, occupation, lifestyle factors, and everyday activities. In cases where the patient’s osteoarthritis is causing significant pain, it is imperative to address the arthritis pain and bring it down to a manageable level in order for the patient to continue with daily activities and preferably be able to participate in a reasonable level of rehabilitation and exercise.

People with osteoarthritis often find that warmth, through warm towels or hot packs applied to the joint, or a warm bath or shower, can relieve pain and stiffness. Heat is known to help reduce inflammation and swelling in the joints and can help improve circulation. Water therapy in a heated pool or whirlpool may also help. In some cases, cold, through cold packs or a bag of ice or frozen vegetables wrapped in a towel, can relieve pain or numb the sore area. Often, applying heat for 20 minutes before doing an exercise routine or activity, and following up with applying cold to the affected area afterwards, will help alleviate activity and exercise related pain in the joints. A physican or physical therapist should be consulted to determine if heat, cold, or a combination of the two is the best treatment.

Many people with arthritis have found substantial relief from their symptoms through physical therapy and exercise. In fact, exercise is thought to be the most effective non-drug treatment for reducing pain and improving movement for people with osteoarthritis. For those with osteoarthritis, the exercises need to be done correctly to avoid causing joint pain. Specific exercises help strengthen the muscles around the joints (removing some stress from the joints), improve joint mobility and reduce joint stiffness and pain.

It has been demonstrated that back and/or neck pain inhibits extensor muscle function, and thus exercises should be focused on those particular muscles. Regular exercise also has a wide range of side benefits, as it typically improves attitude, promotes a healthy level of blood circulation, helps individuals maintain an appropriate weight, promotes endurance, provides more energy, improves sleep, and can even decrease depression.

The patient may be referred to a physical therapist or exercise trainer by his/her doctor in order to determine the appropriate amount and types of exercise. For most, it is very important to work with an appropriately trained physical therapist in order to learn how to do the exercises correctly.

For chronic symptoms or to provide relief from severe episodes of pain from osteoarthritis in the neck or lower back, manipulation (such as chiropractic or osteopathic manipulation) is recommended. The philosophy for manipulations is that joint dysfunction in the spine can produce pain, and mobilizing the spine joints through manipulations (also called adjustments) can decrease that pain.

Since osteoarthritis is a joint dysfunction, it may respond well to mobilization. Manipulation is most often performed by a chiropractor, doctor of osteopathic medicine or a properly trained and licensed physical therapist. A less forceful kind of manipulation, called traction, may also be used, e.g., gravity traction using adjusting blocks.

TENS or Transcutaneous Electrical Nerve Stimulation type of therapy uses small amounts of electricity to reduce sensitivity of nerves around the spine. The treatment has few side effects and is non-invasive; however not all patients receive pain relief. Typically, a physical therapist or a physiatrist will prescribe TENS units and instruct that patient on the proper use.

Acupuncture involves inserting ultra-fine needles at specific points on the skin. Most people report a tingling sensation, feeling relaxed or even energized. Some people have found acupuncture helpful for their osteoarthritis pain, and the NIH has found it useful as a treatment for low back pain and many other conditions including osteoarthritis.

Acupuncture is considered a safe medical treatment. For this reason, many physicians and practitioners believe that acupuncture is a beneficial treatment as an adjunct to other medical treatments, and/or as an alternative to medical treatments. In certain situations, acupuncture may be used in combination with conventional painkillers, or to replace them all together.

Patients with osteoarthritis of the spine who are overweight or obese will benefit from losing excess weight. When appropriate, weight loss can greatly reduce stress on weight-bearing joints and limit further joint injury. Weight control during middle age years can also help prevent the onset of osteoarthritis in later years. A healthy diet and regular exercise are needed to help reduce weight. A dietitian can help patients develop a healthy eating program that will help them lose excess weight and maintain the appropriate weight and mix of nutrients needed over the long term. Active exercise, which burns more calories, also assists with weight loss.

One of the most important things a patient can do is take care of oneself and adopt overall healthy lifestyle habits. Examples of specific healthy lifestyle habits include: getting proper amounts of rest, limiting alcohol and caffeine, not smoking, managing stress, and using good body mechanics for everyday activities (such as carrying a backpack instead of a purse and lifting with the legs instead of the back).

It is advisable to consult a doctor about lifestyle habits and recommendations and about programs designed to develop and reinforce these good habits. If you are experiencing back pain that might be caused by osteoarthritis, please call our office at (304) 263-4927 to schedule a consultation and begin a mufti-faceted treatment plan.

In today’s post, Dr. Zinovy Meyler talks exclusively about how chiropractic adjustments can help alleviate pain and pressure of a cervicogenic headache.

A headache can be caused by a problem in the neck. What we call that is cervicogenic headache. Most of headaches do not come from the neck, most of headaches have a different source, but there is a very specific type of a headache that is called cervicogenic headache stemming from the cervical spine – or in other words, the neck.

Cervicogenic headache usually starts in what we call the suboccipital area, which is that muscular area that is just under the occiput of the head. That pain starts there – it can be on one or both sides – and it tends to radiate up into the head and around the head. The easiest way to visualize it is to actually take the palm of your hand and place it on the back of the head and that really is where the pain spreads. More rarely, the pain can travel to the front of the head and behind the eye. Once again, that’s not common and it is even less common for it to just appear in the front of the head or behind the eye, but it does happen.

What causes a Cervicogenic Headache?

In order to discuss the causes of cervicogenic headache, I need to take a step back for a second and talk about the anatomy. What we’re looking at here is the back of the head, the neck or cervical spine, and specifically what we’re looking at is these little joints. Now these are facet joints – or zygapophysial joints – the hinge-like joints in the spine. Now, these joints are true joints – in other words, they have the synovial fluid, synovial capsule, cartilage – and they can react like any other joint; in other words, they can get irritated, inflamed, and can become painful. Now, what’s important in this context is that the innervations for these joints comes from a very small branch – called medial branch – that comes around here and goes into the joint. At times, that branch continues on and becomes another nerve. The nerve we’re concerned about specifically is called the third occipital nerve. This nerve crosses the C2-3 facet joints and the facet joints are named for the different vertebral bodies that are interfacing and forming that joint, so this is a C2 and C3. So a C2-3 is crossed by the third occipital nerve, then continues onto the occiput and around the scalp. If there is irritation at this joint, this nerve tends to transmit pain and cause the pain that we’re discussing – the pain that actually encompasses the occiput and the back of the head.

Now, the causes of this, there are many to discuss. If we are to group them together, the most common cause is really similar to a whiplash injury. If you think about the joint itself as a hinge-like joint that provides the sliding motion. Whiplash is essentially an acceleration-deceleration injury grinding that joint. That usually is the first step to precipitating this cervicogenic headache because it irritates the joint, then the irritation drives the whole process.

Now, whiplash or acceleration-deceleration injury through that joint can mean motor vehicle accidents, can mean just falls – commonly falls on ice – that cause this motion of the head and that’s usually more common in the younger population. When we talk about the older population and when arthritis becomes more of a problem, that arthritis in that same joint can also cause irritation, inflammation, and irritation to that nerve, causing that cervicogenic headaches. Of course, anything that would cause irritation to that nerve would cause the headaches and muscle spasms, grinding that joints, irritation to the joint from other causes, from the laxity of the joint, in different conditions that really predispose the hypermobility or increased mobility of that joint can also predispose to inflammation and irritation of that nerve, once again predisposing one to cervicogenic headaches.

How is a Cervicogenic Headache Diagnosed?

Diagnosing cervicogenic headache can be somewhat tricky because the headaches resemble a number of different headaches and to complicate the matter, they can trigger other headaches. So, for instance, patients can have cervicogenic headaches as another trigger for a migraine. Cervicogenic headache in itself can cause tension types of headache. But if there is suspicion for cervicogenic headache, the studies have shown that a very precise diagnostic procedure can be very accurate in diagnosing it.

The way this procedure is done is under controlled conditions and the guidance of an x-ray or fluoroscopy. A needle is actually placed at the joint at three separate spots – at the most likely places of this nerve – and anesthetic is placed very precisely at the location of the nerve. If this eliminates the pain, then that’s a very positive indication that that’s the source of the pain.

How is a Cervicogenic Headache Treated?

In discussing treatments for cervicogenic headaches, it’s important to remember that we have to look at it as constellation of symptoms, even though we know that there is a third occipital nerve that gets irritated and that’s what we have to treat, that resolves a part of the problem – a very important part of the problem – but from literature we know that we see the best outcomes by approaching it from several different directions. What I mean by that is: one of the main treatments for cervicogenic headaches is addressing the pain generator. So, reducing the inflammation at the joint and reducing the inflammation at that third occipital nerve is one of the first things to do. That can be done by placing medication right at the source of the inflammation and irritation. Another way to do this – and this is a very well-studied approach – is to use radiofrequency rhizotomy. Radiofrequency rhizotomy essentially eliminates those feeding nerve fibers and the way this is approached is a probe is placed along the path of this nerve and then radiofrequency energy is used in order to treat this area to eliminate those nerve fibers.

Besides using these techniques, what’s important to remember is that cervical manipulations in a gentile manner are addressing the actual myofascial component (muscles, connective tissue of the neck) is very important as well. So, it is important to address this from a point of controlling the pain because, as we know, pain really drives a lot of the muscle spasms and prevents one from doing the exercises and manipulations that are necessary in order to get better. And at the same time, it is important once that is taken care of, it is important to have the patient follow up in a very structured physical therapy that addresses strengthening, postural adjustments, as well as manipulations of myofascial structures and really addressing the muscle tension that is around the head. Once everything comes together and all of the components of the biomechanical chain are treated, the myofascial component is treated, the irritation and inflammation is eliminated, and if necessary those offending nerve fibers are eliminated, most patients tend to recover very well, especially those that had this cervicogenic headache as a trigger for other types of headaches that are really debilitating.

Car accidents are never planned, yet they are those every day occurrences that can significantly change lives forever. The most important thing to do in the day following a crash is to make sure you are healthy and free from pain and injury.

Who Should You See After a Car Accident?

Whether you had a major accident or just a fender bender, it is best to have a follow up with your doctor. If you suspect fractures or internal bleeding, and especially if you hit your head during the crash, you should go to the hospital immediately. Even if you feel just fine after a car accident, it is best to be examined by your primary physician within the next day.

After a major accident, you will want to get X-rays done to ensure that no damage has been done to your skeletal system.

Should You See A Chiropractor After an Auto Accident?

It is best to see a chiropractor shortly after an automobile accident, regardless if it was a major or minor one. Your primary physician can rule out any suspicion of fractures or broken bones through X-rays.

Once immediate health risks are diagnosed and treated with your primary physician, a chiropractor can help with the following:

Reducing Pain: A bad accident can definitely give our bodies a shake up. During the occurrence of an automobile accident, it is very likely that a subluxation or misalignment has happened. Most commonly the place to be affected is the spine because of how a body can jerk forward and backward quickly. This can lead to whiplash and chronic back pain if gone untreated.

Whiplash is a result of a jolt to the spine and is felt in the neck or back region. Some cases of whiplash just cause mild pain because the muscles tense up, but more severe cases can cause excruciating pain and can misalign vertebrae in some individuals. There are also many more injuries that can occur, such as herniated discs or bone fractures. These types of accidents can cause chronic problems if not taken care of immediately, which is why it is important to be seen by a chiropractor as soon as possible.

Restoring Mobility: Car accidents leave many individuals sore after the crash, which is normal. However, many also have a hard time moving as easy as they once did, especially those who are older. If you find yourself in this situation, a chiropractor can increase your joint mobility and help you begin to feel like new again.

Preventing Further Damage: An accident leaves your body and health in less than optimal conditions. Therefore, it is easier for your body to sustain further injuries or ailments from another event, such as a minor slip and fall. Receiving chiropractic adjustments after the accident will help ensure that your body is healing and back to how it should be, which will in turn protect you in the future.

What Can You Expect on Your Chiropractic Visit?

Chiropractors specialize in complementary and alternative medicine. They diagnose, treat, and prevent disorders of the neuro-musculoskeletal system. A chiropractor will use manual techniques to manipulate the positions of vertebrae to alleviate pain and maintain correct positions.

When visiting a chiropractor after a car crash, it is important to describe in detail as much as possible about the car crash so they can recreate the scenario and inspect all areas that may be affected. If possible, it’s a good idea to write down and bring a summary of everything you remember about the accident, including the area of your car that was impacted, as well as the position in which you were seated, the position you ended up in after the accident, and any symptoms that you may feel.

The chiropractor may want to conduct an X-rays, if not brought along to the visit, to confirm that there are no fractures and will probably conduct a full inspection of your neck and back. After their examination and diagnosis, they will form a plan of treatment to get you on your way to a full recovery. There are several methods of reducing muscle stiffness and pain and they will probably do an adjustment to correct anything that may be out of place.

The steps you take in seeking medical attention from all sources in the first days are crucial to your recovery and rehabilitation from pain and injury.

Proper alignment can help reduce a lot of stress in both the lower and upper back, and thus reduce the frequency of conditions ranging from back pain and headaches to carpal tunnel and sciatica. Make sure your workspace—whether a laptop, phone, computer desk, or even your vehicle, is set up for height and functionality. Here are some tips to help you create a better workspace for your spinal health.

Choose a chair that provides back support. Knees should be at 90 degrees and feet should plant comfortably on the floor.

Sit up straight—with support. The discs in your spine are loaded three times more while sitting than standing. You should have a natural curve inward of the spine. Avoid slouching or leaning forward.

Do not cradle the phone between your ear and shoulder. Use a headset or speaker phone to avoid neck pain.

Take regular breaks from sitting in one position for extended periods of time, which can cause muscles to tighten up and become immobile. A short break with stretching every 30 minutes or so is also good for your mental health and productivity.

Staying hydrated throughout the day helps maintain soft tissue elasticity and fluidity in the joints. Spinal discs become vulnerable over time due to loss of hydration and can begin to shrink, which can cause painful conditions such as bulging or ruptures.

Check your shoes. Whether sprinting to the printer or walking blocks to the office, shoes have a big impact on our back. Shoes should be balanced, flexible and comfortable overall. If walking, stair climbing or sprinting is part of your normal work routine, select the best pair for the job.

Keeping your spine in good health during your workday will protect you from injury and degeneration. Listen to your body for the warning signals that you may need to modify your work routine and space. Seek professional care to learn about your spine and the correct for your symptoms.